SYSTEMATIC REVIEW/META ANALYSIS
Year : 2022 | Volume
: 28 | Issue : 4 | Page : 261--267
Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials
Zaheer Nabi1, Rupjyoti Talukdar1, Harshal Mandavdhare2, D Nageshwar Reddy1
1 Department of Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
2 Department of Gastroenterology, PGIMER, Chandigarh, India
Background: Peroral endoscopic myotomy (POEM) is an established modality of treatment for achalasia cardia. Considerable variations exist in the technique of POEM with respect to the length and orientation of the myotomy. In this systematic review and meta-analysis, we compared the outcomes of short versus long myotomy during POEM.
Methods: We searched multiple databases from January 2010 to March 2021 to identify studies reporting on POEM. We selected studies that reported on comparative outcomes of POEM using short versus long myotomy. We performed a comparative analysis of clinical success, procedural duration, gastroesophageal reflux disease (GERD), and adverse events with short and long myotomy in POEM by meta-analysis.
Results: A total of 521 patients from five studies in which 241 patients were treated with short and 280 patients with long myotomy approaches were analyzed. The pooled rate for clinical success gave an odds ratio (OR) of 1.27 (95% confidence interval [CI] 0.50–3.26; I2 = 0; P = 0.62); for hospital stay OR 0.22 (95% CI − 0.03 to 0.46; I2 = 0; P = 0.08); for GERD by esophagogastroduodenoscopy (EGD) OR 0.58 (95% CI 0.31–1.07; I2 = 0; P = 0.08), and for adverse events OR 0.67 (95% CI 0.29–1.53; I2 = 51; P = 0.34). Abnormal esophageal acid exposure was less frequent with OR 0.45 (95% CI 0.22–0.90; P = 0.02; I2 = 0) and the procedure duration was significantly shorter in the short myotomy group with OR − 0.76 (95% CI − 1.00 to − 0.52; I2 = 43; P =0.001).
Conclusion: Short myotomy and long myotomy in POEM seem comparable with each other in terms of clinical success and adverse events. Short myotomy is associated with significantly shorter procedural duration and possibly reduced esophageal acid exposure compared with long myotomy.
Dr. Zaheer Nabi
Consultant Gastroenterologist and Director Interventional Endoscopy, Asian Institute of Gastroenterology, Hyderabad, Telangana
|How to cite this article:|
Nabi Z, Talukdar R, Mandavdhare H, Reddy D N. Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials.Saudi J Gastroenterol 2022;28:261-267
|How to cite this URL:|
Nabi Z, Talukdar R, Mandavdhare H, Reddy D N. Short versus long esophageal myotomy during peroral endoscopic myotomy: A systematic review and meta-analysis of comparative trials. Saudi J Gastroenterol [serial online] 2022 [cited 2022 Aug 15 ];28:261-267
Available from: https://www.saudijgastro.com/article.asp?issn=1319-3767;year=2022;volume=28;issue=4;spage=261;epage=267;aulast=Nabi;type=0